Squamous cell carcinoma of the skin classification: Difference between revisions

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== Overview ==
== Overview ==
Squamous cell carcinoma of the skin is a slow growing invasive non-melanoma skin [[tumour]], which is caused mainly by prolonged exposure to sunlight and other forms of UV radiation. Patients undergo staging as a routine part of their diagnosis and treatment. Staging of the lesion assists the physician to choose which form of treatment strategy suits the patient. The following is the [[TNM]] staging recommended by the [[American Joint Committee on Cancer]] (AJCC) for cutaneous SCC.<ref>http://www.cancer.gov/cancertopics/pdq/treatment/skin/HealthProfessional/page3</ref>
Squamous cell carcinoma of the skin is a slow growing invasive non-melanoma skin [[tumour]], which is caused mainly by prolonged exposure to sunlight and other forms of UV radiation. Patients undergo staging as a routine part of their diagnosis and treatment. Staging of the lesion assists the physician to choose which form of treatment strategy suits the patient. The following is the [[TNM]] staging recommended by the [[American Joint Committee on Cancer]] (AJCC) for cutaneous SCC.


==Classification==
==Classification==


{|style="width:80%; height:100px" border="1"
{| style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" | '''Primary Tumour(T)'''
| style="width:25%" ; border="1" | '''Primary Tumour(T)'''
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| <center>'''TX''' </center>  
| <center>'''TX''' </center>  
|bgcolor="Beige"| Primary tumour cannot be assessed.
| bgcolor="Beige" | Primary tumour cannot be assessed.
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
|  <center> '''T0''' </center>  
|  <center> '''T0''' </center>  
|bgcolor="Beige"| No evidence of primary tumour.
| bgcolor="Beige" | No evidence of primary tumour.
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
|  <center> '''Tis''' </center>  
|  <center> '''Tis''' </center>  
|bgcolor="Beige"| Carcinoma in situ.
| bgcolor="Beige" | Carcinoma in situ.
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
|  <center> '''T1''' </center>  
|  <center> '''T1''' </center>  
|bgcolor="Beige"|Tumour 2 cms or less in greatest dimension.
| bgcolor="Beige" |Tumour 2 cms or less in greatest dimension.
|-  
|-  
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| rowspan="3" | <center>  '''T2''' </center>  
| rowspan="3" | <center>  '''T2''' </center>  
|bgcolor="Beige"| Tumour greater than 2 cms in greatest dimesion.
| bgcolor="Beige" | Tumour greater than 2 cms in greatest dimesion.
|-
|-
|bgcolor="Beige" | Or.
| bgcolor="Beige" | Or.
|-
|-
|bgcolor="Beige" | Tumour any size with >= with high risk features <sup>'''^^'''</sup>.
| bgcolor="Beige" | Tumour any size with >= with high risk features <sup>'''^^'''</sup>.
|-  
|-  
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
|  <center> '''T3''' </center>  
|  <center> '''T3''' </center>  
|bgcolor="Beige"|Tumour with invasion of maxilla, mandible, orbit or temporal bone.
| bgcolor="Beige" |Tumour with invasion of maxilla, mandible, orbit or temporal bone.
|-  
|-  
|-bgcolor="LightSteelBlue"  
|- bgcolor="LightSteelBlue"  
|  <center> '''T4''' </center>  
|  <center> '''T4''' </center>  
|bgcolor="Beige"|Tumour with invasion of skelton(axial or appendicular) or perineural invasion  of skull base
| bgcolor="Beige" |Tumour with invasion of skelton(axial or appendicular) or perineural invasion  of skull base
|-   
|-   
|}
|}
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<sup>'''^^'''</sup>High risk features are as follows.
<sup>'''^^'''</sup>High risk features are as follows.


{|style="width:80%; height:100px" border="1"
{| style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" | '''High Risk Features For Primary Tumour(T) staging'''
| style="width:25%" ; border="1" | '''High Risk Features For Primary Tumour(T) staging'''
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
|rowspan ="3"| '''Depth/Invasion'''
| rowspan="3" | '''Depth/Invasion'''
|bgcolor="Beige"| > 2mm thickness
| bgcolor="Beige" | > 2mm thickness
|-
|-
|bgcolor="Beige"| Clark Level >= IV
| bgcolor="Beige" | Clark Level >= IV
|-
|-
|bgcolor="Beige"| Perineural Invasion
| bgcolor="Beige" | Perineural Invasion
|-
|-
|}
|}


{|style="width:80%; height:100px" border="1"
{| style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" | '''Regional Lymph Nodes(N)'''
| style="width:25%" ; border="1" | '''Regional Lymph Nodes(N)'''
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
|  <center> '''NX''' </center>  
|  <center> '''NX''' </center>  
|bgcolor="Beige"|  Regional  lymph nodes cannot be assessed.
| bgcolor="Beige" |  Regional  lymph nodes cannot be assessed.
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
|  <center> '''N0''' </center>  
|  <center> '''N0''' </center>  
|bgcolor="Beige"| No regional lymph node metastases.
| bgcolor="Beige" | No regional lymph node metastases.
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
|  <center> '''N1''' </center>  
|  <center> '''N1''' </center>  
|bgcolor="Beige"| Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimesion.
| bgcolor="Beige" | Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimesion.
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| <center>  '''N2''' </center>  
| <center>  '''N2''' </center>  
|bgcolor="Beige"| Metastasis is single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension; or in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension; or in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimesnion.   
| bgcolor="Beige" | Metastasis is single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension; or in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension; or in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimesnion.   
|-  
|-  
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
|  <center> '''N2a''' </center>  
|  <center> '''N2a''' </center>  
|bgcolor="Beige"| Metastasis in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension.
| bgcolor="Beige" | Metastasis in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension.
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
|  <center> '''N2b''' </center>  
|  <center> '''N2b''' </center>  
|bgcolor="Beige"|  Metastasis in multiple ipsilateral lymph nodes, more than 6 cm in greatest dimension.  
| bgcolor="Beige" |  Metastasis in multiple ipsilateral lymph nodes, more than 6 cm in greatest dimension.  
|-  
|-  
|-bgcolor="LightSteelBlue"  
|- bgcolor="LightSteelBlue"  
|  <center> '''N2c''' </center>  
|  <center> '''N2c''' </center>  
|bgcolor="Beige"| Metastasis in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension.  
| bgcolor="Beige" | Metastasis in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension.  
|-   
|-   
|-bgcolor="LightSteelBlue"  
|- bgcolor="LightSteelBlue"  
|  <center> '''N3''' </center>  
|  <center> '''N3''' </center>  
|bgcolor="Beige"|Metastasis in a lymph node, more than 6 cm in greatest dimension.
| bgcolor="Beige" |Metastasis in a lymph node, more than 6 cm in greatest dimension.
|-  
|-  
|}
|}


{|style="width:35%; height:100px" border="1"   
{| style="width:35%; height:100px" border="1"   
|style="height:100px"; style="width:25%" border="1" | '''Metastasis (M)'''  
| style="width:25%" ; border="1" | '''Metastasis (M)'''  
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
|  <center>  '''M0'''  </center>  
|  <center>  '''M0'''  </center>  
|bgcolor="Beige"|  <center>  No distant Metastasis </center>  
| bgcolor="Beige" |  <center>  No distant Metastasis </center>  
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| <center> '''M1''' </center>
| <center> '''M1''' </center>
|bgcolor="Beige"| <center> Distant Metastasis </center>  
| bgcolor="Beige" | <center> Distant Metastasis </center>  
|-
|-
|}
|}


{| border="1" cellpadding="4"   
{| border="1" cellpadding="4"   
|+ '''Cutaneous Squamous cell carcinoma'''
|+ '''Cutaneous Squamous cell carcinoma'''
! Grouping !! TNM staging
! Grouping !! TNM staging
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| T2 N0 M0
| T2 N0 M0
|-
|-
|rowspan="4"| Stage III
| rowspan="4" | Stage III
| T3 N0 M0
| T3 N0 M0
|-
|-
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| T3 N1 M0
| T3 N1 M0
|-
|-
|rowspan="6"| Stage IV
| rowspan="6" | Stage IV
| T1 N2 M0
| T1 N2 M0
|-
|-

Revision as of 19:13, 24 May 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2], Raviteja Guddeti, M.B.B.S. [3]

Overview

Squamous cell carcinoma of the skin is a slow growing invasive non-melanoma skin tumour, which is caused mainly by prolonged exposure to sunlight and other forms of UV radiation. Patients undergo staging as a routine part of their diagnosis and treatment. Staging of the lesion assists the physician to choose which form of treatment strategy suits the patient. The following is the TNM staging recommended by the American Joint Committee on Cancer (AJCC) for cutaneous SCC.

Classification

Primary Tumour(T)
TX
Primary tumour cannot be assessed.
T0
No evidence of primary tumour.
Tis
Carcinoma in situ.
T1
Tumour 2 cms or less in greatest dimension.
T2
Tumour greater than 2 cms in greatest dimesion.
Or.
Tumour any size with >= with high risk features ^^.
T3
Tumour with invasion of maxilla, mandible, orbit or temporal bone.
T4
Tumour with invasion of skelton(axial or appendicular) or perineural invasion of skull base

^^High risk features are as follows.

High Risk Features For Primary Tumour(T) staging
Depth/Invasion > 2mm thickness
Clark Level >= IV
Perineural Invasion
Regional Lymph Nodes(N)
NX
Regional lymph nodes cannot be assessed.
N0
No regional lymph node metastases.
N1
Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimesion.
N2
Metastasis is single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension; or in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension; or in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimesnion.
N2a
Metastasis in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension.
N2b
Metastasis in multiple ipsilateral lymph nodes, more than 6 cm in greatest dimension.
N2c
Metastasis in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension.
N3
Metastasis in a lymph node, more than 6 cm in greatest dimension.
Metastasis (M)
M0
No distant Metastasis
M1
Distant Metastasis
Cutaneous Squamous cell carcinoma
Grouping TNM staging
Stage 0 Tis N0 M0
Stage I T1 N0 M0
Stage II T2 N0 M0
Stage III T3 N0 M0
T1 N1 M0
T2 N1 M0
T3 N1 M0
Stage IV T1 N2 M0
T2 N2 M0
T3 N2 M0
Any T N3 M0
T4 Any N M0
Any T Any N M1

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